Ultrasound - Pelvis

Ultrasound imaging of the pelvis uses sound waves to produce pictures of the structures and organs in the lower abdomen and pelvis. There are three types of pelvic ultrasound: abdominal, vaginal (for women), and rectal (for men). These exams are frequently used to evaluate the reproductive and urinary systems. Ultrasound is safe, noninvasive and does not use ionizing radiation.

This procedure requires little to no special preparation. Leave jewelry at home and wear loose, comfortable clothing. You may be asked to wear a gown.

What is Pelvic Ultrasound Imaging?

Ultrasound is safe and painless, and produces pictures of the inside of the body using sound waves. Ultrasound imaging, also called ultrasound scanning or sonography, involves the use of a small transducer (probe) and ultrasound gel placed directly on the skin. High-frequency sound waves are transmitted from the probe through the gel into the body. The transducer collects the sounds that bounce back and a computer then uses those sound waves to create an image. Ultrasound examinations do not use ionizing radiation (as used in x-rays), thus there is no radiation exposure to the patient. Because ultrasound images are captured in real-time, they can show the structure and movement of the body's internal organs, as well as blood flowing through blood vessels.

A Doppler ultrasound exam may be part of a pelvic ultrasound examination.

Doppler ultrasound is a special ultrasound technique that allows the physician to see and evaluate blood flow througharteries and veins in the abdomen, arms, legs, neck and/or brain (in infants and children) or within various body organs such as the liver or kidneys.

A transvaginal ultrasound is usually performed to view the endometrium, the lining of the uterus, and the ovaries. Transvaginal ultrasound also provides a good way to evaluate the muscular walls of the uterus, called the myometrium. Sonohysterography allows for a more in-depth investigation of the uterine cavity. Three-dimensional (3-D) ultrasound permits evaluation of the uterus and ovaries in planes that cannot be imaged directly. These exams are typically performed to detect:

uterine anomalies

uterine scars

endometrial polyps

fibroids

cancer, especially in patients with abnormal uterine bleeding

Some physicians also use 3-D ultrasound or sonohysterography for patients with infertility. Three-dimensional ultrasound provides information about the outer contour of the uterus and about uterine irregularities. See the Sonohysterography page for more information.

In men, a pelvic ultrasound is used to evaluate the:

bladder

seminal vesicles

prostate

Transrectal ultrasound, a special study usually done to view the prostate gland, involves inserting a specialized ultrasound transducer into a man's rectum. See the Prostate Ultrasound page for more information.

How should I prepare?

You should wear comfortable, loose-fitting clothing for your ultrasound exam. You may need to remove all clothing and jewelry in the area to be examined.

You may be asked to wear a gown during the procedure.

Ultrasound examinations are very sensitive to motion, and an active or crying child can prolong the examination process. To ensure a smooth experience, it often helps to explain the procedure to the child prior to the exam. Bringing books, small toys, music or games can help to distract the child and make the time pass quickly. The ultrasound exam room may have a television. Feel free to ask for your child's favorite channel.

What does the equipment look like?

Ultrasound scanners consist of a console containing a computer and electronics, a video display screen and a transducer that is used to do the scanning. The transducer is a small hand-held device that resembles a microphone, attached to the scanner by a cord. Some exams may use different transducers (with different capabilities) during a single exam. The transducer sends out inaudible, high—frequency sound waves into the body and then listens for the returning echoes from the tissues in the body. The principles are similar to sonar used by boats and submarines.

The ultrasound image is immediately visible on a video display screen that looks like a computer or television monitor. The image is created based on the amplitude (loudness), frequency (pitch) and time it takes for the ultrasound signal to return from the area within the patient that is being examined to the transducer (the device used to examine the patient), as well as the type of body structure and composition of body tissue through which the sound travels. A small amount of gel is put on the skin to allow the sound waves to best travel from the transducer to the examined area within the body and then back again.

For ultrasound procedures requiring insertion of the transducer, such as transvaginal or transrectal exams, the device is covered with a sheath and lubricated before insertion.

How does the procedure work?

Ultrasound imaging is based on the same principles involved in the sonar used by bats, ships and fishermen. When a sound wave strikes an object, it bounces back, or echoes. By measuring these echo waves, it is possible to determine how far away the object is as well as the object's size, shape and consistency (whether the object is solid or filled with fluid).

In medicine, ultrasound is used to detect changes in appearance, size or contour of organs, tissues, and vessels or detect abnormal masses, such as tumors.

In an ultrasound examination, a transducer both sends the sound waves and receives the echoing waves. When the transducer is pressed against the skin, it directs small pulses of inaudible, high-frequency sound waves into the body. As the sound waves bounce off internal organs, fluids and tissues, the sensitive microphone in the transducer records tiny changes in the sound's pitch and direction. These signature waves are instantly measured and displayed by a computer, which in turn creates a real-time picture on the monitor. One or more frames of the moving pictures are typically captured as still images. Small loops of the moving real-time images may also be saved.

The same principles apply to ultrasound procedures such as transrectal and transvaginal which require insertion of a special transducer into the body.

Doppler ultrasound, a special application of ultrasound, measures the direction and speed of blood cells as they move through vessels. The movement of blood cells causes a change in pitch of the reflected sound waves (called the Doppler effect). A computer collects and processes the sounds and creates graphs or color pictures that represent the flow of blood through the blood vessels.

How is the procedure performed?

Transabdominal:

For most ultrasound exams, you will be positioned lying face-up on an examination table that can be tilted or moved. Patients may be turned to either side or on occasion placed in a face down position to improve the quality of the images.

After you are positioned on the examination table, the radiologist or sonographer will apply a warm water-based gel to the area of the body being studied. The gel will help the transducer make secure contact with the body and eliminate air pockets between the transducer and the skin that can block the sound waves from passing into your body. The transducer is placed on the body and moved back and forth over the area of interest until the desired images are captured.

There is usually no discomfort from pressure as the transducer is pressed against the area being examined. However, if scanning is performed over an area of tenderness, you may feel pressure or minor pain from the transducer.

Once the imaging is complete, the clear ultrasound gel will be wiped off your skin. Any portions that are not wiped off will dry to a powder. The ultrasound gel does not stain or discolor clothing.

Transvaginal:

Transvaginal ultrasound is performed very much like a gynecologic exam and involves the insertion of the transducer into the vagina after you empty your bladder. The tip of the transducer is smaller than the standard speculum used when performing a Pap test. A protective cover is placed over the transducer, lubricated with a small amount of gel, and then inserted into the vagina. Only two to three inches of the transducer end are inserted into the vagina. The images are obtained from different orientations to get the best views of the uterus and ovaries. Transvaginal ultrasound is usually performed with you lying on your back, possibly with your feet in stirrups similar to a gynecologic exam.

Transrectal:

For a transrectal ultrasound, a protective cover is placed over the transducer. It is lubricated and then placed into the rectum.

Usually, you lie on your side, facing away from the examiner, with your knees and hips slightly flexed.

Doppler sonography is performed using the same transducer.

When the examination is complete, you may be asked to dress and wait while the ultrasound images are reviewed.

What will I experience during and after the procedure?

A clear water-based gel is applied to the abdomen. A transducer is moved back and forth over this area until the desired images are captured.

Ultrasound examinations are painless and easily tolerated by most patients.

For a transvaginal exam:

With transvaginal ultrasound, although the examination is often performed to look for a cause of pelvic pain, the sonogram itself should not be painful or significantly increase your discomfort. A vaginal sonogram is usually more comfortable than a manual gynecologic examination.

For a transrectal exam:

If no biopsy is required, transrectal ultrasound of the prostate is similar to or may have less discomfort than a rectal exam performed by your doctor.

If a biopsy is performed, additional discomfort (due to the needle insertion) is usually minimal because the rectal wall is relatively insensitive to the pain in the region of the prostate. A biopsy will add time to the procedure.

If a Doppler ultrasound study is performed, you may actually hear pulse-like sounds that change in pitch as the blood flow is monitored and measured.

These ultrasound examinations are usually completed within 30 minutes.

After an ultrasound examination, you should be able to resume your normal activities immediately.

Who interprets the results and how do I get them?

A radiologist, a physician specifically trained to supervise and interpret radiology examinations, will analyze the images and send a signed report to your primary care physician, or to the physician or other healthcare provider who requested the exam, and he/she will share the results with you. In some cases the radiologist may discuss results with you at the conclusion of your examination.

Follow-up examinations may be necessary, and your doctor will explain the exact reason why another exam is requested. Sometimes a follow-up exam is done because a suspicious or questionable finding needs clarification with additional views or a special imaging technique. A follow-up examination may also be necessary so that any change in a known abnormality can be monitored over time. Follow-up examinations are sometimes the best way to see if treatment is working or if an abnormality is stable or changed over time.

Risks

What are the limitations of Pelvic Ultrasound Imaging?

Ultrasound waves are disrupted by air or gas; therefore ultrasound is not an ideal imaging technique for air-filled bowel or organs obscured by the bowel. In most cases, barium exams, CT scanning, and MRI are the methods of choice in such a setting.

Large patients are more difficult to image by ultrasound because greater amounts of tissue attenuate (weaken) the sound waves as they pass deeper into the body.

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